|AYAs presenting with hepatosplenomegaly should be referred immediately to a specialist.||C|
|AYAs with a mediastinal or hilar mass on chest x-ray should be referred immediately to a specialist.||C|
AYAs should be referred urgently to a specialist if they have lymphadenopathy with one or more of the following, particularly if there is no evidence of local infection:
AYAs should be referred immediately to a specialist if they have shortness of breath in association with the above signs; particularly if the shortness of breath is not responding to bronchodilators.
Symptoms and signs
The majority of lymphomas (70-80%) arise from the lymph nodes; the rest develop outside the nodes. Signs of lymphoma include adenopathy, mediastinal obstruction, abdominal mass, hepatomegaly, splenomegaly; common symptoms include fever, night sweats, weight loss, loss of appetite and enlarged lymph nodes (usually in the neck, under the arms or in the groin). Tender lymph nodes are usually benign. If glands in the chest are involved, shortness of breath or coughing may occur, while glands in the abdomen may cause bowel blockages.
Non-Hodgkin’s lymphoma can present with lymphadenopathy, breathlessness, superior vena-caval obstruction or abdominal distension and symptoms usually progress rapidly.
Adolescents and young adults (AYAs) presenting with hepatosplenomegaly (simultaneous enlargement of the liver and spleen) or a mass (mediastinal or hilar) on chest x-ray should be referred immediately to a specialist.
General practitioners (GPs) should refer AYAs presenting with lymphadenopathy and key symptoms of lymphoma (such as lymph nodes that are non-tender, firm or hard and/or progressively enlarging; and fever or weight loss) to a specialist urgently. Shortness of breath in association with these features, particularly if not responding to bronchodilators, is also an indication for urgent referral.
Investigations such as FBC, x-ray and CT scan (where appropriate) may be initiated by the GP, but should not delay referral. Patients should be referred to specialists for biopsies or fine needle aspirates, if required.
Infectious mononucleosis may increase the risk of Hodgkin lymphoma by two to three fold. Non-Hodgkin’s lymphoma has been linked to immunosuppressive therapy and immunodeficiency syndromes (e.g. ataxia telangiectasia).
However, lymphoma can occur in AYAs without any of these risk factors.
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- National Collaborating Centre for Primary Care. Referral Guidelines for Suspected Cancer. Clinical guideline 27. London: National Institute for Health and Clinical Excellence; 2005.
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